Idaho Voters Ponder Ballot Question on Expanding Medicaid

“It’s probably popular because a lot of people don’t realize the facts about what it’s really going to cost,” one Idaho lawmaker says of the ballot question. The proposition would expand eligibility for Medicaid as part of Obamacare, an option available for states since 2012. (Photo: Ingram Publishing/Newscom)

Idaho Republicans have made it clear to voters: Reject a proposition on the ballot that would expand eligibility for Medicaid as part of Obamacare.

Nearly 30 Republican members of the Idaho House of Representatives and legislative candidates announced their opposition to Proposition 2, citing concerns that the ballot initiative would take away funding from other state programs.

“Proposition 2’s Obamacare expansion, with its ballooning costs, will threaten the proper funding of our schools, roads, and every other public service,” state Rep. Bryan Zollinger, R-Idaho Falls, said in a Sept. 27 press release.

The Republicans also warned that the expansion would be fiscally irresponsible, citing past federal budget deficits as well as other pricey Medicaid expansions already undertaken by states such as California.

The proposition will appear on ballots in Idaho in November.

State Rep. John Vander Woude, R-Nampa, told The Daily Signal in a phone interview that the Idaho initiative “makes us more dependent on the federal government, which is basically already broke.”

“If history is any indication, all the states that have expanded [eligibility for Medicaid], their numbers have been anywhere from 100 to 200 percent of what their estimates were. [In Idaho] it will be higher than what people think it will be,” Vander Woude said.

Nina Schaefer, a senior research fellow at The Heritage Foundation, told The Daily Signal that the proposition would expand the state’s Medicaid program to cover able-bodied children and adults.

“This is not the traditional Medicaid population,” she said in a phone interview.

Idaho and Medicaid

Medicaid is a government program that traditionally provides medical care for the needy, including pregnant women, children, and the disabled.

In a 2015 report, the Idaho Department of Health and Welfare estimated the state’s Medicaid enrollment averaged about 252,598 a month in fiscal year 2014.

About 91,000 additional Idahoans are projected to enroll for Medicaid under the expansion, according to a July report from Milliman Inc., a health insurance consulting firm.

State legislatures have had a say in whether Medicaid must cover able-bodied adults since a 2012 Supreme Court ruling that the Affordable Care Act (popularly known as Obamacare) could not require states to do so.

The match rate is the percentage of costs for those made newly eligible for Medicaid that the federal government will pay, with the state picking up the rest.

Under the Obamacare law, the match rate for the Medicaid expansion is as high as 90 percent (far above the current Idaho and national match rates, 71 and 60 percent, respectively).

Schaefer said Medicaid expansion shifts the burden from state to federal taxpayers in a significant fashion. Moreover, other programs at the state and federal levels will suffer from this shifting of resources to Medicaid.

“It really does a disservice for the traditional [Medicaid] population,” Schaefer said.

“It creates a perverse incentive at the state level to seek out this [new] population rather than seeking to improve the program for the traditional population.”

‘Obamacare Failing’

Fred Birnbaum, vice president of the Idaho Freedom Foundation, a state-based conservative think tank, told The Daily Signal that he sees expanded eligibility for Medicaid as part and parcel of the Obamacare law.

A single-payer system is one in which the government provides a single type of national health insurance. Most private health insurance is illegal or restricted.

Schaefer said she sees Idaho Republicans’ opposition to the ballot initiative in a positive light.

“It shows Republicans are taking a serious and long-term look at what the impact would be for the state of Idaho,” she said. “It’s not about being against helping those without insurance … but [about] what is the proper vehicle to help these people.”

Schaefer said conditions are different in Idaho than in other states, so Idaho legislators should prefer a tailored rather than cookie-cutter approach.

‘Fiscally Responsible’

Birnbaum, of the Idaho Freedom Foundation, said he agrees.

“The money going toward Medicaid expansions should be bundled and block-granted to the states, so the states can prioritize,” he told The Daily Signal.

But not everyone thinks expanding Medicaid eligibility in Idaho is a bad idea.

“Proposition 2 is the fiscally responsible thing to do for Idaho,” state Rep. Christy Perry, R-Nampa, said in a quote sent to The Daily Signal by The Fairness Project, a Washington, D.C.-based nonprofit.

“It brings hundreds of millions of our tax dollars back from Washington to create jobs and provide health care to the 62,000 Idahoans who desperately need it,” Perry said. “In addition to having the support of a majority of likely Republican voters, organizations such as the Idaho Association of Commerce & Industry, the Boise Metro Chamber, the Idaho Sheriffs’ Association, and many provider groups and medical organizations support Proposition 2.”

The Fairness Project provided $500,000 to get the proposition on the Idaho ballot by hiring signature-gatherers, according to the Post Register, an Idaho Falls-based newspaper.

The nonprofit, which has focused on raising the minimum wage in multiple states, bills itself as concerned primarily with “economic fairness” and argues that Medicaid expansion is a matter of providing health coverage to low-income adults.

Jonathan Schleifer, executive director of The Fairness Project, argued that his organization’s actions are justified in the wake of repeat Republican efforts at the state and federal levels to gut the Affordable Care Act.

“We didn’t have time to flip the [U.S.] House and the Senate in 2016 to play defense on the ACA,” he said to The Hill news organization.

“The place we found the greatest opportunity to go on offense and create the clearest message that Americans don’t want less health care, they want more, is through expansion,” Schleifer said.

Spending on Ballot Questions

The Hill reported that The Fairness Project has spent around $5 million in the past year to get similar Medicaid expansion proposals on the ballot in five different states: Idaho, Nebraska, Utah, Montana, and Maine.

The nonprofit already has seen success in Maine, where it collected enough signatures to get an initiative expanding Medicaid onto the ballot after Gov. Paul LePage, a Republican, repeatedly vetoed similar legislation. Voters later passed the ballot initiative.

Birnbaum called The Fairness Project “a group funded by California labor unions.”

“It’s a perfect example liberals trying to buy influence in Idaho,” he said.

When asked whether he thought influence on Idaho elections by nonprofits from outside the state is a concern, Vander Woude told The Daily Signal: “It is when they’ve tried to promote it as a grassroots initiative, when it wasn’t at all. It was almost entirely out of state. Generally, Idahoans frown upon this.”

Schleifer doesn’t look at his organization’s activities this way.

“It’s powerful that we have a vehicle for people to be able to take charge of their own lives and actually make policy themselves when it’s so clear to them that their elected officials are failing,” he told The Hill.

The Fairness Foundation would not provide a comment to The Daily Signal.

‘What It’s Really Going to Cost’

Regardless of the concern over outside meddling, Vander Woude predicts the initiative likely will prove popular among voters.

“It’s probably popular because a lot of people don’t realize the facts about what it’s really going to cost,” the Idaho Republican said.

The ballot initiative “polls as high as it does because the mainstream media in Idaho are in favor if it,” Birnbaum told The Daily Signal. “We believe the mainstream media and large hospitals are pushing a false narrative.”

However, Birnbaum said he is hopeful:

If Idahoans are properly educated, they will reject Medicaid expansion because this is a conservative state and Medicaid expansion is Obamacare.

Sixty-two percent of Idahoans have a negative opinion of Obamacare. We believe if properly educated they will reject this proposition at the polls.

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